Post-Eligibility Treatment of Income

 

The post eligibility calculation is made to determine how much an individual in an institution (usually a nursing home) is able to contribute to cost of his/her own care. It applies only to individuals who are institutionalized (most commonly to those in nursing facilities) and to certain individuals receiving home and community-based waiver services. The process only applies to those with income and only after their Medicaid eligibility has been established.

The contribution is determined by first calculating the individual's total income and then deducting certain amounts from that income. Specifically, the individual's contribution is his or her total income less the following deductions (often referred to as "protected amounts"):

A personal needs allowance of at least $30;

If there is a community spouse and the spousal impoverishment rules discussed above apply, a community spouse's monthly income allowance (at least $2,002.50 but not exceeding $2,980 for 2016), as long as the income is actually made available to the community spouse;

A family monthly income allowance, if there are other family members living in the household;

An amount for medical expenses incurred by the spouse who is in the medical facility.

Once the above items are deducted from the institutionalized individual's income, any remaining income is contributed toward the cost of his or her care in the institution.

Spousal ImpoverishmentThe post eligibility calculation is made to determine how much an individual in an institution (usually a nursing home) is able to contribute to cost of his/her own care. It applies only to individuals who are institutionalized (most commonly to those in nursing facilities) and to certain individuals receiving home and community-based waiver services. The process only applies to those with income and only after their Medicaid eligibility has been established.

The contribution is determined by first calculating the individual's total income and then deducting certain amounts from that income. Specifically, the individual's contribution is his or her total income less the following deductions (often referred to as "protected amounts"):

 

• A personal needs allowance of at least $30;

• If there is a community spouse and the spousal impoverishment rules discussed above apply, a community spouse's monthly income allowance (at least $2,002.50 but not exceeding $2,980 for 2016), as long as the income is actually made available to the community spouse;

• A family monthly income allowance, if there are other family members living in the household;

• An amount for medical expenses incurred by the spouse who is in the medical facility.

 

Once the above items are deducted from the institutionalized individual's income, any remaining income is contributed toward the cost of his or her care in the institution.

 

 

For More Related Topics or Detail on Medicaid, please visit the government's website: 

https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html